What is Anesthesiology?
Anesthesiology is the field of medicine concerned with pain relief during surgery. Drugs are given to provide analgesia, amnesia, hypnosis, and muscle relaxation. Safe anesthesia involves very potent drugs and close patient monitoring. Anesthesiology also includes managing medical problems immediately before, during and after surgery (called the perioperative period).
What is an Anesthesiologist?
An anesthesiologist is a consultant physician, a medical doctor with an MD or DO degree, who specializes in the anesthetic care of patients before, during, and after surgical or obstetrical (labor and childbirth) procedures. The anesthesiologist is trained to manage the often multiple, serious medical conditions of patients while they undergo major surgical operations, and to advise the surgeon in preparing such patients medically prior to the surgery.
In addition, our specialty encompasses the management of pain, both the acute pain that can follow surgery or childbirth, as well as chronic pain conditions that can result from illness or injury. After college, and four years of medical school, the physician must serve a period of internship and residency, a combination of theoretical school and hands-on apprenticeship that lasts four years, during which time the trainee learns the science and craft of our specialty. After successful completion of this intensive training period, the graduate is eligible to submit to a rigorous set of written and oral examinations administered by experts in our field. If these examinations are successfully passed, the anesthesiologist becomes a Diplomate of the American Board of Anesthesiology or the American College of Osteopathic Anesthesiologists - that is, he or she is board-certified in anesthesiology.
What is a Nurse Anesthetist (CRNA)?
A nurse anesthetist is a registered nurse with experience in the care of critically ill patients, who has obtained additional training in the administration of anesthetics to surgical and obstetrical patients.
The nurse anesthetist attends an accredited nurse anesthesia education program of two to three years’ duration, and upon graduation must pass a written national certification examination. Successful completion of this examination earns the graduate the designation CRNA, or Certified Registered Nurse Anesthetist.
The training and practice of the CRNA is comparable to that of other advanced-practice nurses, such as nurse-clinicians or nurse-practitioners. Anesthetists work closely with, and under the medical supervision of, a physician. Anesthetists provide anesthesia care in a variety of professional settings, such as hospital or outpatient surgical center operating rooms, labor and delivery suites, pain management clinics, and physicians’ offices.
Types of Anesthesia
During surgery, you will be given some form of anesthesia. The type and dosage of anesthesia is administered by the anesthesiologist or nurse anesthetist. When a patient faces surgery, he or she will meet with their anesthesia provider before the procedure. The anesthesia provider will review the patient’s medical condition and history to plan the appropriate anesthetic for surgery.
Local anesthesia is medicine given to temporarily stop the sensation of pain in a particular area of the body. A patient remains conscious during a local anesthetic. For minor surgery, a local anesthetic can be administered via injection to the site. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, doctors may resort to regional anesthetics.
General anesthesia causes a patient to be unconscious during surgery. The medicine is either inhaled through a breathing mask or tube, or administered through an intravenous line (usually in the patient's forearm). A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. Once the surgery is complete, the anesthesia provider ceases the anesthetic and the patient wakes up in the recovery room.
Regional anesthesia means numbing only the portion of the body which will be operated on. Usually an injection of local anesthetic is given in the area of nerves that provide feeling to that part of the body. There are several forms of regional anesthetics, two of which are described below:
Spinal Anesthesia - often used for lower abdominal, pelvic, rectal or lower extremity surgery. An anesthetic is injected into the fluid in the spinal canal.
Epidural Anesthesia - this anesthetic is similar to a spinal anesthetic and also is commonly used for surgery of the lower limbs. It is also very popular as an anesthetic during labor. A thin catheter is placed in the "epidural" space, which is in the middle and lower back, just outside of the spinal space.
Acute Pain Management
In addition to intravenous medications and epidurals continued postoperatively, there are many specific nerve blocks that we at Metro-West Anesthesia Group can use to assure a patient's comfort following a surgical procedure. Our anesthesia providers will discuss the advantages and disadvantages of these techniques. There are several nerve blocks we perform, two of which are described below:
This is used for surgery of the shoulder or proximal humerus and involves an injection in the neck. An interscalene block is an approach to the brachial plexus (collection of nerves that control the shoulder and arm providing movement and sensory innervation). Long-acting local anesthetics can commonly provide up to sixteen hours of post-operative pain relief with a single injection. Your surgeon may ask us to place a catheter for a continuous infusion. Common side effects include numbness on the side of the face, hoarseness, a droopy eyelid and redness in the eye. These side effects will resolve as the block wears off.
Femoral Nerve Block
This is used for surgery of the knee (generally for total knee replacement and anterior cruciate ligament reconstruction) and involves an injection in the groin. Blockade of the femoral nerve provides sensory anesthesia of the anterior thigh, knee, and medial aspect of the calf, ankle and foot. Long-acting local anesthetics can commonly provide up to sixteen hours of post-operative pain relief with a single injection. Your surgeon may ask us to place a catheter for a continuous infusion.